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Changing the hospital network in health insurance coverage: find out what has changed

In August 2023, the Supplementary Health Agency (ANS) approved new rules for changes in the hospital network of health insurance operators. Initially, these rules were due to come into force on March 1 this year, but the deadline was extended to September 1, 2024. The ANS explained that this extension was necessary to give operators and the agency itself time to adjust their systems to the changes brought about by the new rules.

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The changes apply both when a hospital is removed from the network and when it is replaced by another. The aim is to make the process more transparent and safer for beneficiaries. The main changes include expanding the portability rules, requiring individualized communication, and ensuring that the new hospital maintains or improves the quality of service in the accredited network.

Find out more about the changes below.

Portability

If a beneficiary is not satisfied with the removal of a hospital or emergency service, both in the area of residence and where the health insurance coverage was contracted, they can switch to another [coverage] without waiting for a minimum period, previously set at 1 to 3 years. Additionally, it is no longer required for the new coverage to be priced the same as the previous one.

Communication

Operators are now obliged to inform consumers individually of any exclusion or change in hospitals and emergency services accredited in the city where the beneficiary lives. This individual notice must be given 30 days before the service is terminated.

Network reduction

If a hospital that is to be removed is responsible for up to 80% of admissions in its service area, the operator cannot simply remove it, but must replace it with another.

Replacing hospitals

To choose a new hospital, the ANS will analyze whether it offers the same hospital and emergency services as the previous one over the last 12 months. If so, these services must be offered at the new hospital. If the hospital to be removed is one of the most used, they can’t remove just a few services from it.

The new hospital must be in the same city as the old one, unless there is no other available. In that case, it can be in a nearby town.

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